Chinese Medicine and the Flu: I Say Tomato, You Say 西红柿

Everyone knows that there is very little that Western medicine can offer for the common cold and flu. And every Chinese person is similarly convinced that famous Chinese medicines like ban lan gan ke li, yin qiao jie du pian, or gan mao qing re ke li work really well for similar symptoms. As a doctor struggling to offer patients flu symptom relief, I would love to strongly endorse Chinese medicines for this, but it is a huge struggle to find good evidence as to what works. Why is that?

We Speak Different Languages, on Many Levels

One fundamental issue is that even the question, “which TCM works for the common cold?” isn’t a properly formed question in many Chinese eyes. That’s because the disease definitions themselves are different. For example, the common cold in Western eyes is the same description no matter what time of year you get it. But in traditional Chinese doctor’s eyes, there are many types of “ganmao” or flu depending not only on weather but other physical symptoms they see on exam; it may be wind-cold, or wind-heat, or a deficiency, among others.

So, when I talk to my clinic pharmacist or TCM doctor about which medicine is best, they would say similar things like “this is better for winter cold” or “no, this helps expel heat, but not sore throat”. And the actual indications on the box say the same thing; nothing would just say “for common cold”. And many TCM doctors would also stress that the pre-packaged formulas are usually not as effective as the pharmacy-made medicines, as each illness each time may be different, so the herbal brews may need to change. That may be true, but again, from my perspective of providing evidence-based care to my patients, I need concrete indications of illness and similarly stable choices of medicines, more in line with Western medicines. Perhaps this wide perception gap will never be closed, but I will continue to believe that certain TCM herbal compounds will show consistent results over placebo and would pass the same stringent randomized controlled trials that every medicine in the West must pass.

Back to the Common Cold: What TCM Works?

As I’ve said, I’ve had difficulty finding good research (translated into English) regarding TCM and the common cold or flu. There are a lot of internet sources discussing treatments, but I’ve yet to find any that are quoting any randomized clinical trials that prove effectiveness over placebo. One website of note is the Cochrane Database, whose main purpose is to perform strong reviews of many common questions, including which Chinese medicines or acupuncture work. This year they put out a review of chinese medicines for the flu. Unfortunately, their plain-language summary states:

…This review assessed the prophylactic and therapeutic effects as well as safety of Chinesemedicinal herbs as an alternative and adjunctive to other commonly used drugs for uncomplicated influenza. Two studies involving 1012 participants were included in the review. The trial quality and evidence were poor and do not support or reject the use of any Chinese herbal preparations for influenza. Well-designed trials are required.

There are a couple other excellent websites (from Natural Medicines Database and Medscape) which mention specific “alternative” ingredients which are common to many Chinese medicines that may indeed help the common cold and flu. But again, it’s difficult to make that next leap and decide which packaged TCM medicine has those ingredients.

Where To Find Evidence-Based TCM?

Many Western doctors are very interested in Chinese medicine and, like me, would love to see the same level of clinical research as we are used to with our standard Western medicines. I assume there is a lot of research done only in Chinese, and the main problem for me is access. Many Western research groups are indeed trying to study Chinese medicines with a more Western definition of diagnoses, but the research will take many years. In the meantime, I’ve found a few websites which provide objective, evidence-based analysis:

I would love this post to be the beginning of a good discussion here, and I encourage anyone out there to please send me the best studies that prove TCM’s effectiveness for the common cold and flu. Hopefully, in a few weeks I can truly be comfortable offering more treatment alternatives for my patients.